Pix'n'Mix Phase 3A (3)

Question 1

Clinical features of carpal tunnel

Answer 1

Tingling 
Numbness
Worse at night 
Pain radiating down wrist 
Thenar muscle atrophy 
Thumb adduction

Question 2

List the contra indications of doing a lumbar puncture

Answer 2

Platelet less than 50 x 10(9)
Respiratory distress 
Shock 
Seizures 
Reduced consciousness

Question 3

Outline the mode of action of SSRI’s

Answer 3

Blockade of the reuptake of serotonin

Acts predominantly at the prefrontal cortex

Question 4

List the cancers which metastasise to the bone

Answer 4

Bronchus
Thyroid
Kidney
Prostate

Question 5

List the two endocrine agents used in breast cancer and where they target

Answer 5

Oestrogen receptor: Tamoxifen

HER2 receptor: Herceptin

Question 6

List the most common type of breast cancer

Answer 6

Adenoma

Question 7

Treatment of ? meningitis in the community

Answer 7

Benzylpenicillin (IV/IM)

Question 8

List the triad seen in Wernickles encapathlopathy

Answer 8

Intranuclear opthamolplegia
Ataxia
Confusion

Question 9

List the symptoms of delirium tremens

Answer 9

Clouding of consciousness 
Liluputian hallucinations 
Disorientation 
Amnesia 
Psychomotor retardation 

Rx with Benzos

Question 10

Outline the key features of Juvenile myoclonic epilepsy

Answer 10

Onset adolescent
Seizures are myoclonic
Shortly after waking
Tiredness can increase the number of seizures

Question 11

List the predisposing of CHARGE

Answer 11

Coloboma of the eye 
Heart defects 
Atresia of the choanae 
Retardation of growth 
Genital abnormalties 
Ear abnormalties 
L

Question 12

List the predisposing features seen in NEC

Answer 12

IUGR
PDA
Preterm
Polycthmia 
Aphyxia 
Early rapid enthral feeding

Question 13

Key features seen on X-ray for

• osteosacroma
• edwings sacroma

Answer 13

Osteosarcoma: sunburst appearance

Edwings sacroma: onion skin

Question 14

List the features of androgen insensitivity syndrome

Answer 14

46 X,Y
No response to testosterone 
Structures don't develop 
Regression of the malarian inhibit factors
NOT A GIRL OR A BOY

Question 15

Clinical test used to diagnosis developmental dysplasia of the hips

Answer 15

Barloms

Ortalami

Question 16

Keys signs of abuse in a child

Answer 16

Torn frenulum labi superiourus
Scalds
Ligature marks

Question 17

Outline the investigations that you would do in suspected MG

Answer 17

Tensilons test
Ach receptor abs
Nerve conduction studies
Ct for a thymoa

Question 18

Features of mitral stenosis

Answer 18

Low volume pulse 
AF 
Raised JVP 
Undisplaced apex beat 
mid diastolic murmur

Question 19

What does the median nerve supply

Answer 19

"LOAF"
Lateral lumbricals 
Opponenes pollices 
Abductor pollicis
Flexor pollicis brevis

Question 20

What does the AMT consist of

Answer 20

Recall and address 
Date of birth 
Recognition of two people 
Place 
Year 
Name of monarch 
Name of prime minister 
Date WW2 ended 
Count backwards from 20

Question 21

What type of anaemia is typically seen in alcoholics

Answer 21

Macrocytic anaemia

Question 22

List the features of corticobasal syndrome

Answer 22

Presents as an asymmetrical cortical syndrome 
Gait unsteadiness 
Parkinsonism 
Aprexia
Alien limb syndrome

Question 23

List the features of cerebellar lesions

Answer 23

Dsdiodochokinesia 
Ataxoa 
Nystagmus
Intentions tremor 
Slurred speech 
Hypotonia

Question 24

Sign of phenytoin toxicity

Answer 24

Cerebellar syndrome

Question 25

What are the features of an argil robertson pupil and what causes it

Answer 25

Pupil accommodates but does not react

Caused by syphillis

Question 26

Name the hallucination commonly seen in coke addicts

Answer 26

Formications

Question 27

Risk factors for suicide

Answer 27

Male 
Middle aged 
Depressed 
Previous attempt 
Substance abuse 
Chronic disease 
Organised plan 
No social support 
Self harm

Question 28

Antidote to benzodiazapines

Answer 28

Give flumazeine

Question 29

Define folie á deux

Answer 29

Shared delusional disorder where 2 codependent people develop a paired delusion

Question 30

Causes of delirium

Answer 30

Degenerative disease 
Epilepsy 
Liver failure 
Intracranial injury 
Rheumatic chorea 
Uraemia 
Infection 
Metabolic

Question 31

Management of hypercalcaemia of malignancy

Answer 31

Ca > 3mmol/L
Rehydrate with 4-6L of normal saline over 24hrs
Once rehydrated
- IV pamidronate or zoledronic acid

Monitor fluid status and serum calcium

Question 32

Side effect of memantine

Answer 32

Hallucinations

Question 33

Emergency management of APH

Answer 33

MILD

• Set IV infusion
• HB, cross match, grp and save
• Obs
• Locate placenta
• placenta prevue stay in hospital until >37wks
• minor abruption can go home if foetus not in distress

SEVERE

• IVI
• Bloods
• Raise legs
• O2/15L
• Fresh ABO/Rh compatible blood
• Cathetise and monitor output
• Deliver promptyl
• Active management of 3rd stage

Question 34

Emergency management of PPH

Answer 34

• O2 ( intubate if loss of consciousness)
• x2 IV access large bore cannula
• Bloods ( LFT’s clotting)
• Cross match 6 units ( put out haemorrhage alert 222)
• IV fluids
• Catheterise for UO
• Deliver placenta
• Bimanual compression
• Drugs (Syntometrin, ergometrine, oxytocin infusion, misoprostolol, carboprostolol)
• Take to theatre
• Repair tears
• Still bleed
  1. Rush ballon
  2. B-lynch suture
  3. Internal iliac/uterine artery ligation
  4. Subtotal/total hysterectomy